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The original title of my presentation for the Ancestral Health Symposium 2013 was:

But now I feel like it should be more like:

What’s going on in Paleoland? Well, you can see Melissa McEwan’s take on it here, or itsthewoo’s take on it here. My concerns about paleo are wrapped up in the presentation below, and going into AHS 2013 I was more than a little nervous about saying what it is I wanted to say. See, I don’t consider myself “paleo” (or “low carb” or “insert whatever diet therapy you think I adhere to here”); I consider myself a nutritionist, a public health professional, and work in progress. I do recognize the fact that a lot of people who do consider themselves “paleo” attend AHS–and I consider a lot of them my friends and colleagues. While I see promising things in the group of people who have chosen a paleo path, I also agree with a great deal of what both Melissa McEwan and itsthewoo have to say. (I admit to some sadness over the demise of Paleodrama. Other people binge-watch House of Cards. Me, after a long week of rhetorical theory and critical studies, I would grab a tumbler of sangria and binge-read Paleodrama. To each her own.) The presentation would, I hoped, put some of the “issues” that I see happening in Paleoland on the table, without throwing out the potential for paleo to grow into something more than itself. Well.

Without further ado, here’s the presentation as it was in August. Updates and commentary that did not appear in the original are in [brackets].

It is an honor to be here at AHS and I am delighted to be in such esteemed company. I hope that I can bring to our conversations this weekend a little something to offend everyone.

The primary misconception that I deal with in public health nutrition is that our current policy is the same thing as science. Conversely, a primary misconception regarding reforming this policy is the idea that “If only we could get the right information to the public and to policymakers, things would be different.” Having the evidence to support a movement’s agenda is important, but public perceptions and national policies are shaped as much by social, political, and cultural forces as by science.

As we have seen in other movements, cultural change drives policy change, which in turn drives cultural change. The current mainstream definition of what constitutes a “healthy” diet is an excellent example of this. At one point in the not-too-distant past, a low-fat, low-calorie, plant-based diet was considered a “fad” – just as the stereotypical paleo diet is today. But it was not science alone—or even primarily—that shifted the public’s perceptions.

In fact, the science supporting this dietary guidance has been and remains weak, but that didn’t stop it from becoming policy. George McGovern’s Senate Select Committee, a group of young white liberal men full of well-meaning social concern, wanted to create a plan to reduce chronic disease (a reasonable public health goal), as well as lengthen the lifespan of their committee. They did their work against a backdrop of post-World War 2 wealth, comfort, and suburban complacency that was rapidly crumbling in the face of social movements that would polarize the population: civil rights, women’s liberation, and anti-war protests. Television brought bombings, riots, assassinations, and Watergate, into middle class living rooms and shook middle class faith in government and social order. Middle class complacency was quickly turning into anxiety and cynicism.

Some of this anxiety took shape specifically around matters related to food and health. Ancel Keys taught the public his theories about heart disease–a “disease of success” brought on by too much animal fat. Rachel Carson raised awareness of environmental toxins. Ralph Nader and the Center for Science in the Public Interest raised the alarm about chemicals in our food supply put there by corporate greed—a force which also was accused of contributing to hunger in America. Many groups, from feminists to Beatles fans, picked up on these issues—along with ethical concerns about animal welfare—by turning towards vegetarian diets. McGovern’s committee—as they said back then—was hip to all of this.

This is clear in their choice of reference material for the Dietary Goals, which included—of all things—a cookbook called Diet for a Small Planet. As much vegetarian manifesto as a source for recipes, it proposed that a plant-based diet was the best way to feed the hungry, save the Earth, protect our health, and usher in the Age of Aquarius. [It still does.] This cookbook assured middle-class America that what was good for us was also good for the world. Its influence is felt throughout the 1977 Goals, which counseled Americans to reduce consumption of meat, eggs, butter, and full-fat dairy, and increase intake of grains, cereals and vegetables oils, recommendations that have changed very little in nearly 40 years.

McGovern’s committee wanted to return America to a more “natural” way of eating—and what could be wrong with that? This “back to nature” stance earned the Committee the nickname “the barefoot boys of nutrition.” This “back to nature” idea not only recalled the “physical culture movement” that had long been a part of American life, it resonated with Puritan ethics that suggested that self-discipline and a little suffering—which Americans were going to need for such a radical change in diet—were a mark of moral goodness. Barefoot and back to nature, fresh air, sunshine and a little suffering—does any of this sound familiar?

Those initial Dietary Goals did not embed themselves in American culture based on the strength of their science—to say the least. They grabbed the attention of the media and the middle class because they played on the existential anxieties that cultural turmoil creates. They substantiated a notion that by changing their diets, Americans could control some of the frightening things in the world—hunger, pollution, disease. We could demonstrate just how much we cared about these issues, and we could do it from the comfort and safety of our own dinner table. We are still trying to do that even now.

Our current calls for reform in the areas of food, nutrition, and health reflect the same set of complex social problems, the same inescapable environmental problems, the same threats to our food supply that the creators of the 1977 Goals faced—only compounded by time, technological advances, and a distinct turn for the worse in the country’s (and the world’s) health.

The paleo community emerged as a protest against dietary guidance that seems to many to be scientifically shoddy, shallow, limited, and ineffective. The attention to calorie balance as the only way to maintain health seems to be especially—and unnecessarily—restrictive and unhelpful. But “paleo” in its stereotyped form takes a shape that is little different from the one to which it stands in opposition.

Both of approaches to nutrition are stuck in the past in two primary aspects:

Both suggest a linear and mechanistic approach to the food-health relationship. “Eat this/don’t eat that and all will be well.”

Second, and more subtly, both approaches reflect the cultural values and social power of those doing the reforming, but may not reflect the realities of the most vulnerable in our population, the ones who might benefit most genuine changes to the system.

People have been burnt once already by a “nutrition revolution” – they are confused, skeptical, and wary. They don’t want to get fooled again. Right now, paleo is not offering much that is truly revolutionary in terms of a new way to approach to food and health. Unless and until we are ready to give up some of the same concepts that we criticize the mainstream approach for using–it’s really just “meet the new boss, same as the old boss.”

We can’t generate the outrage we need to change the public’s world view, because we have not decided what our own priorities are: Do we care only about our own food and health, or do we care about everyone’s food and health?

With regard to food, current nutrition policies are a barrier to the growth of local food systems.

We want our meat, eggs, and butter to come from happy, healthy cows and chickens. But what attention are we willing to spare for the health and happiness of farm workers—or the workers up and down the food supply chain?

With regard to health, nutrition is a civil rights issue.

We don’t want our wellness determined by an arbitrary marker like LDL, but are we willing to go to bat for someone else whose wellness is determined by an arbitrary marker like BMI?

The paleo community spends its energy debating how various sugars and starches may or may not be paleo. This is fascinating, but will it help people with diabetes who are never offered an alternative to a low-fat diet—despite the science that demonstrates the benefits of a carbohydrate-reduction in treating this disease?

These are huge issues—wicked problems—and we can’t fix them by replacing the old rules with some new ones. In order to be a leading force in the kind of social movement that might create authentic change in the system, paleo is going to have to move beyond the limited perspective that perpetuates many of the mistakes of the current nutrition paradigm.

I propose that we consider the idea of ancestral health—as distinct from “paleo”–as a way of framing food and nutrition reform to address both the cultural and the scientific limitations of previous approaches.

In terms of science, anthropology and evolutionary biology have shown us that diet is idiosyncratic and variable within and between populations, but not chaotic; there are certain nutritional requirements, but there are many ways to meet them.

Research into the human microbiome has shown us that we are not alone; and that the health of the microbial communities within and around us is a critical aspect of our own health.

Epigenetics, genomics, and other aspects of systems biology have begun to reveal the complexity of interactions between our genetic material and our environment, with food being a primary, but by no means the only, environmental exposure.

All of these concepts can and should be part of the ancestral health framework.

But as I said at the beginning, science is not enough. There are three critical components that turn a protest into a movement.

1) Development of widely-shared cultural norms, the violation of which is perceived as injustice. In order to develop those norms, we’re going to have to do some GROWING UP.

2) Development of a repertoire of actions that demonstrate that conditions can be altered. In order to create the sense of agency and change that we want, we are going to have to start DIGGING IN.

3) Development of a dense social networks that can work collectively against a common target. In order to create these alliances, we are going to have to begin REACHING OUT.

Growing up for paleo—as for many things—will to need to start with a little makeover. Like all good makeovers, this doesn’t mean abandoning the paleo identity completely, but it means looking—and moving—beyond it. There are precedents for this from other nutrition reform arenas.

For many people, hearing the term “vegan” bring a knee-jerk—and negative—reaction; but the term “vegetarian” does not. People who promote a vegan diet know this and can frequently be found using the term “vegetarian” instead. So that’s a marketing strategy, and a fairly wise one.

Now, take the phrase “Atkins diet” which can also elicit a negative, knee-jerk reaction. But scientists who study such diets have learned to use the phrase “reduced-carbohydrate” not only for PR purposes, but because the phrase “Atkins diet” does not encompass the different approaches to carbohydrate reduction that scientists are interested in.

How about paleo? It also elicits a negative, knee-jerk reaction from many and calls up stereotypes of privileged white males eating big hunks of meat on a stick—even though, as Hamilton Stapell showed us, those stereotypes may be somewhat inaccurate. As such, the term “paleo” limits what we can expect to accomplish as a framing device for conversations about food, health, and lifestyle. From this point forward I will use the term “paleo” to refer to the stereotyped and limited perspective and “ancestral health” to refer to an expanded and comprehensive approach to food-health reform.

By shifting the shared norms of our community towards an ancestral health framework—rather than being limited to paleo—we can move beyond the outdated concepts that we share with the current approach to nutrition and the problems that they create. We can—if we choose to—use an ancestral health framework to challenge those assumptions in a truly radical way.

[What follows is what I call the Top Ten Reasons Paleo Pisses Me Off, but my hubby, ever the diplomat, said not to say that.]

[Reason 10:] So let’s just get this out there: The first assumption we need to challenge is the one that equates body size with health, which is interesting since according to Dr. Stapell, both of these are primary reasons to become part of the paleo community.

Mainstream approaches indicate that overweight and obese Americans need to eat less and move more to achieve a healthy weight according to an arbitrary cut-off on a simplistic measuring tool.

The paleo approach suggests that maybe strong is the new skinny. Or maybe “strong” is just another superficial way of assessing another’s worth.

The problem is that attention to body size rather than health and functionality can lead to a moralizing and pathologizing perspective that doesn’t reflect reality. Not only can this approach foster disordered eating behaviors and judgment calls about food, character, and lifestyle choices, it tells us little about overall health. We have no way of knowing, looking at these two women (Brittany on the left and Jennifer on the right—no headless women here), who eats what kind of food, who is healthy now, or who is going to live a long and functional life.

Our challenge is to use the ancestral health framework to recognize that a multiplicity of body shapes can be healthy and functional, and to acknowledge that much of body shape and size is determined genetically and can be influenced by factors other than diet and exercise. De-emphasizing body shape/size brings our focus to health, and especially for women, inter-generational health.

Women can—and do—have bellies, butts, and bingo flaps. Sisters who rock the paleo hardbody look—more power to you. Sisters who are more the Venus of Willendorf type—more power to you too. We can all meet at the pool and compare muscles & bra sizes & bingo flaps—and just get over ourselves and any fear of somebody tweeting about our butts.

[Reason 9:] Growing up also means moving beyond the idea that food and nutrition are the same thing.

Typical nutrition guidance discusses food as if all food choices are based only on nutrition.

Yeah, we tend to do the exact same thing.

The Problem: People are concerned about a lot of other things besides nutrition. Usually cost, convenience, and taste come first–

–followed by a host of other considerations, only one of which is nutrition.

An ancestral approach to food can embrace all of the factors that impact our food choices because it can look at food in its cultural—as well as biological—context. It can highlight the role of environmental stressors in overall health–including economic and time pressures that also impact food choices. Acknowledgement of food communities allows us to explore the role food beliefs and preferences play in food choices; these too are part of an anthropological and evolutionary perspective on food-health relationships.

Now, I’m not going to say that the paleo paradigm doesn’t have some better biochemistry behind it; in many [but not all] respects, it does. The problem is that food is still not medicine.

A nutritionally-appropriate diet should be the foundation of good health, but it doesn’t guarantee it. Both groups are making promises they can’t keep & this leads to skepticism, cynicism, and disillusionment. Most importantly, this framework take a complex social construct and a biological necessity—food—and reduces it to a mechanistic and simplistic intervention–medicine.

Medicine is for sick people and food is for everyone. We may use food as part of a therapy to “heal” a particular condition at a particular point in time, but that is not the same thing as a public health paradigm. We put casts on broken legs, but we don’t recommend that everyone wear casts in order to prevent legs from breaking.

An ancestral health approach offers an opportunity to move away from the view of the human condition as one of potential “illness” to be “avoided” to one of wellness to be maintained. By focusing first and foremost on essential nutrition—and the many appropriate ways that it can be acquired–the emphasis is on having health, not preventing chronic disease. The recognition of the complexities of what we know and don’t know about the relationships between food and health brings into the public health forum other important aspects of lifestyle—sleep, stress, play, activity—that can contribute to health and well being.

Mainstream nutrition suggests that returning to a “more natural” diet means eating a lot foods that our ancestors DIDN’T eat—either in the near or distant past—like vegetable oils, and avoiding a lot of foods they DID eat, like butter, eggs, meat, and lard.

Paleo suggests that returning to a “more natural” diet means NOT eating a lot of foods that our ancestors DID eat—at least in the not too distant past—like bread, legumes, and dairy, [and eating a lot of foods they DIDN’T eat i.e. coconut milk, unless your ancestors were Thai].

The problem is that “natural” is term useful for marketing, but not much else. It isn’t a scientific concept, or even one that makes a lot of sense culturally. We don’t really have a lot of solid information about what was “natural” for our distant ancestors—and the gene/environment interactions that may have occurred since then may make that information less relevant than how our more-recent ancestors lived, ate, and worked.

Here’s our challenge: Ancestral health principles got their start by focusing on paleolithic times—and that perspective is a valuable one—but we don’t have to be limited to that. An ancestral health framework can also allow us to look to the near-past for clues about our health now, should we choose to. Here’s the beauty of this approach: It’s already been sanctioned by mainstream nutrition, and by two of the leaders in nutrition reform, Michael Pollan and Gary Taubes.

In his landmark 1985 article, Sick Individuals and Sick Populations, epidemiologist Geoffrey Rose called for “The restoration of biological normality by the removal of” among other things “recently-acquired dietary deviations.” Gary Taubes indicates that Weston A. Price’s work about the health impacts of introducing new foods into native diets as the “most influential” thing he read in researching Good Calories, Bad Calories. Michael Pollan suggestion that we eat the way our great-grandparents ate has become a rallying cry for many people interested in food reform.

[The pie chart above] is a pretty reasonable picture of an “ancestral diet” from 1955 America: we got about half of our calories from plant-based starches and sugars—only 10% of those as fruits and vegetables—and about half from mostly animal-based proteins and fats. I’m not saying this is a perfect diet, but it does seem to be the one we were eating before the rapid rise in obesity and diabetes.

An ancestral framework can help us analyze the differences between how this food environment may be similar to or different from our current one, without having to invoke a past that didn’t exist, as the plant-based folks must in light of this information—or a past that is so distant that it’s hard to say what we really know about it [as the paleo folks must]. On the other hand, the 1955 –style 50/50 diet looks remarkably familiar. It’s not that hard. Or is it?

[Reason 6:] Well, we make it hard by invoking food rules that don’t always make a lot of sense. Everyone’s current favorite, on all sides of the nutrition issue, is: Avoid processed foods.

Problem: Food rules means splitting hairs, drawing lines in the sand, and creating arbitrary divisions—and they usually end up making the food rule makers look silly at best and hypocritical at worst. Food rules are the easiest things to dismiss, discount, or disprove. We’re already enmeshed in a set of arbitrary, unreasonable, and incoherent standards [called the Dietary Guidelines for Americans]; no one is interested in a new and different one.

Skip the food rules. What we need are guiding principles from an ancestral health perspective that can apply to individuals, industry, and policymaking processes. For instance, if we frame concerns around the “recently acquired dietary deviations” I just mentioned, we have a guiding principle—upon which Geoffrey Rose, Gary Taubes and Michael Pollan all agree—for looking at the current scientific literature and for conducting future investigations. We might go back a few generations or many generations; either way we can remain true to our generational perspective of health without limiting ourselves to a particular set of food rules.

[Reason 5:] The politics of responsibility are a no-win situation for the public.

Mainstream nutrition assures folks that, if the low-fat, low-calorie diet isn’t working for you, you’re not doing it right. Paleo people assure newbies that if the high-fat, no-calorie-counting paleo diet isn’t working for you, you’re not doing it right.

And when that logic doesn’t fly, both groups blame the “obesogenic” environment.

Problem: Both approaches assume that “If only that poor sick, fat person had the “right” food or the “right” information or the “right” environment, they’d stop being so fat and sick.” These approaches call for policy reforms that will force industry to make “the healthy choice the easy choice” for people apparently deemed too irresponsible or stupid to make the healthy choice otherwise. But industry is responsible to the public, not for the public. That’s the job of public health.

Challenge: An ancestral health approach recognizes that poor health may be as much an outcome of environmental impacts and generational health—especially prenatal health–as food choices and activity. This shifts the focus away from the politics of responsibility and puts the attention on food industry and policy reform where it belongs, not on a product—which the consumer may or may not choose—but on the processes over which consumers have little control: federal approval of food additives, food and farm workers rights, food safety and food waste, environmental impacts of our current agricultural practices, and many other food-related practices, program, and polices that have been ignored in favor of telling people what to eat and do and blaming them when it doesn’t work.

[Reason 4:] This one is a real “I’m rubber, you’re glue” thing. We complain about all those mainstream nutrition articles making sweeping generalizations about how animal fats will kill you—then we turn around and make sweeping generalizations about how vegetable oils will kill you. The vast majority of these claims—on both sides of the table–are unproven and even untested; in many cases they are untestable. [The science for both claims is primarily observational; other science may be experimental, but based on animal models and cell cultures. The few randomized, controlled dietary trials that exist are just that, highly controlled. The populations may or may not be generalizable to larger populations; the methods may or may not translate to the “real world.”]

Science and medicine as they have been practiced in America for the past half a century (or more) have relied on a mechanistic approach to these relationships that is now rapidly giving way to more complex thinking. The mechanistic approach has served the industries of research, medicine, food and pharmaceuticals–because what is simplified can be controlled–but it hasn’t served the health of humans.

Ancestral health principles can help us think about science differently. Nutrition science as it is practiced now is backwards looking—especially nutrition epidemiology which relies upon ancient datasets gleaned from populations which are hardly representative of our current world. It ignores the complex relationships between ourselves, our environment, and our heredity that science has more recently uncovered. Despite its name, ancestral health represents a forward-looking framework. As an approach to public health, it can herald a shift to a more holistic, yet evidence-based focus that recognizes individual, community, environment, and generational impacts on health. Consider the ancestral health community’s active encouragement of n of 1 experimentation. It is a perspective that can go beyond Joe Paleo fiddling with his macronutrient ratios to a place of leveraging new biomedical technology, new ways of modeling complex relationships, and a new focus on patient-centered outcomes to create a revolution in how we approach the science of diet and health. This is not anti-science, but an embrace of science in all its complexity. Such an approach brings us to our biggest philosophical challenge:

[Reason 3:] Can we acknowledge that one diet will not be right for everybody?

Right now, mainstream nutrition asserts that everyone will benefit from eating a low-fat, low-calorie diet.

At the same time, the paleo community asserts that everyone will benefit from eating a paleo diet.

The problem with a top-down, unilateral imposition of one-size-fits-all dietary recommendations is the same as it was in 1977: Who asked you to come up with a diet for me that might or might not help prevent a condition that I may or may not be concerned about? Remember that a skeptical public doesn’t want to get fooled again. New arrivals to our country, who aren’t yet aware of the abysmal failure of our current nutrition system, are being greeted with admonitions to give up traditional foods like eggs and meat—but then paleo doesn’t have a much different message to offer, except that instead they should give up traditional foods like bread and beans.

Ancestral health principles embrace the notion of change. Ancestral health acknowledges complexity. It only makes sense that an ancestral health approach to public health would recognize diverse paths to acquiring appropriate nutrition, with a focus on foods high in nutrient value, and frame dietary information in terms of the diversity of individual, cultural, environmental, and generational contexts. But will it?

[Reason 2:] Many of the assumptions I’ve mentioned are deeply embedded in our thinking, and reflect the concerns, values, and social power of the mostly white, well-educated, well-paid, predominantly female thirty-somethings that make up the paleo community. Not that there’s anything wrong with that—information from other datasets have shown that white, well-educated women are also the ones that most closely adhere to the Dietary Guidelines food pattern, so the presence of this demographic in paleo may reflect an overall concern not only for weight and appearance, but for family and health. This is a good thing. This particular demographic also has a long history of being the backbone of successful social reform movements—from child labor to drunk driving laws.

But ladies—and gentlemen—we are going to have to do more than vote with our forks or food dollars.

Both paleo and plant-based reform efforts seem to believe that your financial support of the food you’d like to see other people eating is the best way to change the food-health system. You can just munch your way to a better world without ever having to encounter anyone who doesn’t appreciate the change you’re creating for them.

For paleo eaters, increased demand may increase production, making some foods more affordable for some people. It may support some farmers—as long as they keep up with and adhere to all of the “appropriate” [and possibly contradictory, unrealistic, and/or absurd] paleo food rules—but it isn’t necessarily going to change the status quo for the most vulnerable in our population, the ones most subject to the effects of dietary policy as it stands now. Me buying my eggs locally doesn’t help the low-income mothers who would like to spend their federal assistance farmers market vouchers on local eggs too, which they are not allowed to do. Face it, in the “vote with your food dollar” approach, some folks have a lot more votes than others. Changing your diet is not enough to change the world. We are going to have to put down our forks and dig in.

One of the things any successful social change effort has is a story, where the victims of injustice can be rescued from evil by the heroes. A successful social change effort also has a way for everyone—from individuals to the government—to be a hero. This takes the form of a repertoire of actions for changing conditions. These concrete actions give a sense of agency and urgency to the cause; they say to the world: come join us, we are being the change we want to see.

Being a hero and acting from a place of our own food-health values, however, does not mean going out into the world and trying to impose those values on someone who hasn’t asked for our help. Instead, it means sharing the privilege of health we have in a useful way [and this is a privilege based much more on social class than diet], so that others may have the food and the health that they want—just as we wish to have the food and health that we want. How can we do that?

For example: An ancestral health framework recognizes the importance of protein as essential to a nutritionally-adequate diet. But protein is also the single most expensive food source to provide to the less fortunate. Because it is so expensive, it also means that protein is the food source most lacking in diets of those who are in most need.

Community level programs can ripple outward and upward – and if they are organized with an ancestral framework in mind, those ideas ripple outward and upward as well.

Farm to Family initiatives bring food from local farmers to local, low-income families at prices they can afford—an effort that supports local farmers as well as community members at risk for hunger and poor nutrition. These initiatives typically focus on fresh produce, but some include meat and eggs—and wouldn’t the world be a better place if even more of them did? College students with mad social networking skills can mobilize volunteers and connect resources to get the program off the ground. Local public health agencies and faith-based organizations can raise awareness so that families at highest risk can be reached—and so their wants and needs can be heard and honored. Individuals and families can donate time and money, while businesses can facilitate logistics with donations of materials or space. Feedback from the community can support policy change at local, state, and federal levels.

The ancestral health community has the sort of talent to pull an effort like this off, but it involves not just getting out of the house, but getting out of our comfort zones.

[Reason 1:] The lack of diversity that often comes with being part of a community of like-minded people presents both an epistemic challenge and a logistical one. It can lead not only to closed minds, but to closed doors. Being able to act from a place of ancestral health principles—rather than paleo rules—can make it easier to reach out to others–the final thing needed to build a social movement.

Confirmation bias has been a pervasive aspect of mainstream nutrition, and in opposition to it, paleo culture often seems to have adopted a similarly insular stance. It can be reinforced by influence and funding, but most often it is simply a way of not being challenged in our own beliefs.

In mainstream nutrition, the USDA and HHS write the Dietary Guidelines. They also finance the research and the experts that they later choose for their “evidence-based analysis” of these guidelines, so it’s no surprise that both the research and the experts support the status quo.

Paleo leaders also have a vested financial interest in being paleo leaders—books, speaking engagements, products, and other various funding streams—just as paleo followers have an interest in remaining comfortable in their chosen ideology. We support our leaders; they tell us what we want to hear.

This problem, also known as epistemic closure, echo chambers, or a circle jerk, is that these positive feedback loops end up welcoming only people that think exactly like the people already in the group. Sadly, the smarter you are, the better you are at confirming your own beliefs about things—and we have a lot of wicked smart people in the paleo community. Unfortunately, circle jerks quickly turn into cluster, let’s call them “efforts” – where the circle of closed thinking causes the very problems that the circle of closed thinking is unable to address exactly because of its closed nature. Which is sort of where we are now—both in mainstream nutrition and in paleo.

Much of mainstream nutrition has built-in alliances with academia, industry, advocacy groups, and policymakers. In order to make our voices heard, we will need to establish connections with other communities who will work with us on common issues. The general rule in building networks of alliances is that there are no permanent friends and no permanent enemies; everyone is a future ally. You work together on issues and projects as long as your goals align.

This may make for strange bedfellows at times, but if we want to be more than a passing fad, we are going to have to reach out of our comfort zone and connect with other communities with whom we may not feel an immediate kinship but with whom we share some core values.

For example, the Health at Every Size community. This community has a strong presence in academic circles that look at feminist and diversity issues. While an alliance based on paleo thinking might not make sense, the ancestral health framework would have much in common with these Health at Every Size principles.

Other communities with whom we are likely to have some common objectives are: other alternative food movements–yes, including vegans; sustainable agriculture and permaculture communities; government accountability groups; and hunger groups. We don’t have to agree on everything, just our shared goals. We can learn from them and they can learn from us.

We can reach out to foundations, the media, professional organizations, and faith-based communities. And it doesn’t have to be on a national level. We can find influential allies in these groups in our own local communities.

And in fact, that’s where I would urge us to start. As a community, we exist both nowhere and everywhere—which can make us feel more at home at places like AHS than we do in our own towns. But, to quote Rick Ingrasci, if you want to create a new culture—throw a better party. One of the wonderful traditional things we do as humans is celebrate and build community with food—but it’s hard to celebrate if you are busy agonizing, analyzing, and criticizing your—or your neighbor’s—food. We have the opportunity to NOT be those nutrition reform people.

I’m going to end with a story about last year’s Food Day in Durham, NC. This is sponsored by the Center for Science in the Public Interest, which operates from a plants-are-better, saturated-fat-kills perspective. At an organizational meeting last year, a room full of young white women—and one white male—were busy wringing their hands over the lack of diversity at last year’s Food Day events. Now Durham is a very diverse little city. In Durham, we talk more about race than NASCAR fans talk about racing. But Food Day tends to be an almost all-white event involving mostly college kids from Duke rather than people from the community. Why oh why is that? these ladies (and one gentleman) wanted to know. I suggested that maybe it’s because no Food Day events serve meat—and there are lots of local meat, egg, and cheese producers that we could support by promoting their foods. These women looked at me as if I had just created a loud, legume-based bodily emission—and the topic was never mentioned again.

Well, we can throw a better party. We can appeal to a wider, more diverse, and inclusive community. It will mean growing up, digging in, and reaching out. But there are plenty of people out there who are hungry for a sense of identity, for connection, and for change. Ancestral health as a social movement can serve that purpose, as well as serve our communities—and we can serve it with a side of bacon.

The “thank you” slide is my shout-out to those who have helped me think about the issues I’ve raised.

Postscript: At some point during the AHS 2013 weekend, I pulled Aaron Blaisdell aside and asked him what the deal was with paleo and AHS. Here’s his response as I remember it (and I hope he will correct me if I misrepresent him). He said something to effect of: AHS is about bringing an evolutionary perspective to health, including but not limited to matters relating to diet and nutrition. Darwin’s evolutionary perspective has been an incredibly powerful tool in other areas of biology for understanding why things are the way they are and for formulating hypotheses and testing them out, but it is often neglected when it comes to health particularly in matters of food and diet. AHS is about promoting that perspective, not about promoting a particular diet. [See Aaron’s comments below for an expansion on this. Note to self: Drink that glass of wine after you ask Aaron Blaisell questions like that.]

I heaved a big sigh of relief. “Paleo” I can do without–just as I can do without all of those other conveniently-labeled approaches to diet and health with massive cognitive bias blind spots: vegan, vegetarian, low-carb, low-fat, “eating the food,” whatever, whatever (although I’m happy for the people who find that being part of those communities gets them on a path to health that works for them). So I guess this is my massive cognitive bias blind spot. I still love those AHS folks.

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A beautifully-written summary by Emily Contois regarding the recent Critical Nutrition Symposium held at UC-Santa Cruz. Organized by Julie Guthman, author of Weighing In, this symposium brought together food scholars from around the country (plus me) and invited us and the audience to participate in a thought-provoking and nuanced conversation about food, nutrition, culture, and ways of knowing.

On March 8, 2013, I had the pleasure of attending the Critical Nutrition Symposium at UC Santa Cruz, organized by Julie Guthman, author of Weighing In. The event was spawned from a roundtable discussion at last year’s Association for the Study of Food and Society conference. The symposium brought together an interdisciplinary group of scholars to critically examine what is missing from conventional nutrition science research and practice, discuss why it matters, and brainstorm how to move forward in an informed and balanced way. What follows are a few of my favorite key ideas from the day’s discussions.

Adele Hite, a registered dietitian and public health advocate who is not afraid to ask big and delightfully confrontational questions regarding nutrition science, began the day by dissecting Michael Pollan’s now famous aphorism—Eat food. Not too much. Mostly plants. Step by step, she revealed the decades of revisionist myth…

The best that we can say is that since the 1970s, rates of myocardial infarction have decreased slightly—but only in white folks.

If the current health prescription is valid, then we should see dramatic differences in rates of disease and mortality between those who follow the prescription and those who don’t, and we should see clear and strong associations between “healthy” food choices and good health (because the same people eating a “healthy” diet are also taking care of their health in other ways). Yet this is not what we see.

Is it possible that our low-fat diet has removed some protective factors from our nutritional profile and exposed us to increased levels of nutrients that have negative impacts on health? I think it is, and a recent study in BMJ supports this notion.

I am a long-time admirer of one of the researchers, Daisy Zamora, and she is a good friend of mine. She’d been dropping hints about this great study she was working on for a while now—but was sworn to secrecy and now I know why. What she and her co-investigators have uncovered is data from a long-ago diet study, conducted from 1966-1973. It’s a decently large, well-run, randomized controlled trial that replaces saturated fat with safflower oil, a vegetable oil particularly high in one kind of PUFA—omega-6 (n-6) linoleic acid—and low in another kind of PUFA—omega-3 (n-3) alpha linolenic acid. The idea was that replacing “bad” saturated fat with “healthy” vegetable oil in men with premature coronary heart disease would improve survival. This did not turn out to be the case. For some reason, though, the original study only reported all-cause mortality and not deaths from cardiovascular disease and coronary heart disease.

Daisy and her co-investigators climbed into their way-back machine and this is what they found: Not only did the participants in the intervention group have an increased risk of all-cause mortality, but they had an increased risk of death from cardiovascular disease and coronary heart disease.

The blue line is the safflower oil group; the red line is the control group. To put it rather simplistically, the widening gap between the two groups means the intervention group died a lot faster than the controls.

Although the switch to safflower oil did lower total cholesterol, these reductions didn’t help those participants live any longer than those who kept eating saturated fat. In fact, as the authors note, “the increased risk of death in the intervention group presented fairly rapidly and persisted throughout the trial.” (Hmm. Maybe this whole “cholesterol lowering” thing isn’t as important as we thought.)

Furthermore, the authors go on to point out that the relationship between linoleic acid consumption and increased mortality was particularly robust in smokers and drinkers, “suggesting that diets high in n-6 [linoleic acid] may be particularly detrimental in the context of oxidative stress induced by smoking and alcohol.”

Everyone knows that if you are a smoker you should quit and that alcohol should be used in moderation. But, with this evidence in mind, if you decided to keep on smoking and/or you want to drink immoderately, you may want to consider a breakfast of eggs and bacon rather than whole wheat toast and “heart healthy” margarine before you do.

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I’d like to introduce readers to a friend and fellow grad student, James Woodward. His undergraduate work was in economics at Ohio University, and he has a Master’s in public policy from the University of Kentucky. He is continuing at UK as a PhD student in public policy and administration. He and I have had some of the most thought-provoking email threads in any of my correspondence & I give him a lot of credit for helping me think through the economics and policy parts of food-health system reform puzzle. His post will serve as a bridge to my next series on “Eatanomics” which will explore how food, health, and the economy are intertwined. James would like everyone to know that all the disclaimers that appear on this page apply equally to what appears in this post. His views are his own, and as with the best of minds, he anticipates that most are subject to change. But he raises some very interesting questions—he’s nearly as long-winded as I am, but it is worth a read.

Why New Science May Not Be Enough – James Woodward

Before going into my social science background, I thought I would mention my professional background as it relates to food. It’s nearly as extensive as my academic background. I worked in fast food for about two years, a pizza place for about two years, a dining hall for a quarter, and, finally, a pseudo-Mexican restaurant for about two years. As a result, my feelings toward actual food and, especially, its preparation are fairly ambivalent at this point. The fact that I spent large amounts of time working with flour (I made tens of thousands of tortillas over the course of my tenure at the Mexican place) is rather ironic given my recent decision to avoid the stuff as much as possible.

Nutrition Science Initiative founders Gary Taubes and Peter Attia are hoping to give the public some solid science on food-health relationships.

My schooling in economics was concurrent with much of this work and my reasons for working these jobs had much more to do with my own economic situation than with any particular desire to work with food. But my background in economics and, now, public policy, leads to me to view the issue of food and nutrition policy a bit differently than many others writing on this topic. Many approach problems relating to nutrition and health in terms of their public health consequences. Others stress the fact that nutrition policy is the product of bad and/or misinterpreted science. Gary Taubes and Peter Attia just launched their organization, NuSI, to address, and hopefully settle, that particular aspect of this issue. Both lines of research clearly have their merits. Ultimately, though, I think what everyone is most interested in is influencing the behavior of individuals.

Contrary, perhaps, to Peter Attia’s quote from Richard Feynman in a recent blog post, I think there is a role for social scientists to play in understanding the many issues and controversies surrounding diet, health and public policy. Some of us in the social sciences are, in fact, sensitive to the difficulty of establishing real truths from the data available to us. Further, I do not think that social phenomena like behaviors and decision-making are reducible to physical and chemical relationships quite yet. How fitting that nutrition, and especially nutritional epidemiology, often bears more resemblance to bad social science than it does to any sort of ‘hard’ science.

Ignoring the controversy surrounding what it is that makes people fat and what constitutes an ideal diet, it would be hard to argue that people are making “good” decisions about what they are eating, given the high prevalence of (ostensibly) diet-related health problems in the United States, the most visible of which is obesity. Since most people buy their own food rather than growing or raising it themselves, food buying decisions tend to be highly correlated with food eating decisions. So, to me, the ultimate question is: “What influences food buying decisions?” Again, Gary and Peter have, with good reason, chosen to stress the importance of food consumption decisions being driven by good science. But there are clearly more factors that influence food purchasing decisions than a careful weighing of the scientific evidence. I would argue that such an approach to most decisions is, in fact, fairly rare. To the extent that Gary and Peter are ultimately trying to influence public policy, I think it is self-evident based on a reading of the history that policymakers are not that likely to employ such an approach either.

One of the many things besides science that may influence food purchasing and consumption.

This is why I tend to conceptualize the problem in the area of food and nutrition policy as one of bad information rather than attributing it purely to bad science. If one takes the time to dig, there is plenty of science which refutes the conventional wisdom regarding the relationship between diet and health. So, while no rigorous, carefully controlled studies have been performed to refute the conventional wisdom and/or confirm the “insulin hypothesis”, to use Gary’s term, there is already a lot of evidence to suggest that it is valid and plenty of evidence which refutes the conventional wisdom. Performing such a rigorous test of these competing theories is obviously warranted, given the importance of the implications for settling this debate, but there is no guarantee that the results will be convincing to skeptics, policymakers, stakeholders or the public at large.

Thirty-odd years ago policymakers perceived an obvious threat to public health (saturated fat) and saw a clear remedy (tell people not to eat so much saturated fat) which made it more or less a no-brainer to act on that information and tell people to avoid eating saturated fat containing foods. Since then, those original beliefs about diet and health have had time to percolate and become more or less embedded in how most people think about what they eat. Adele and I have talked a little bit about overcoming our own biases when we decided to eat differently, biases that we were not necessarily aware we had in the first place.

How you spend your food dollar may depend on how many food dollars you have to spend.

There are more factors that influence food purchasing decisions than just beliefs about how that food will affect one’s health. Taste, culture, geography, morality, ethics, politics, and socioeconomic status are just a few observable characteristics of an individual that might affect what he or she decides to eat. In many people’s minds, there is very little conflict between these concerns and health-related ones. For example, there is a perception that following a vegetarian lifestyle is good for one’s body, one’s soul, and the environment compared to a diet based around animal products. Upon closer inspection, however, there is a great deal of ambiguity to this belief in all three spheres. Similarly, many athletes seem to be operating under the impression that carbohydrates are required to perform at a high level. Peter’s well-documented experience calls that belief into question. Breakfast is often lauded as the most important meal of the day in the United States yet I frequently snub it to no ill-effect. And so on.

I think it is important to keep these biases in mind when thinking about we’d like to go about changing behavior. It is tempting to think “if only the science were better” people’s behavior would change. This is clearly not enough, in my mind anyway. It is just as important to be convincing as it is to be right. If/when NuSi successfully settles this debate and has the biggest names in the field to back up its research; there is still the matter of convincing everyone else. NuSi does acknowledge this aspect of the issue, though I am interested to see how it is addressed in practice. There are the cognitive biases of all the other scientists to contend with. There are also the material and non-material incentives that seem to be ingrained in many of the stakeholders involved in this particular area of policy. For example, it has been noted elsewhere that stressing the importance of calories is convenient for those involved in the production of food since doing so means no particular foods (e.g., wheat and sugar) are likely to be admonished against because of their unique effects on the body per se but, rather, because of their caloric content. I have to imagine that such firms will do their very best to refute any evidence that says otherwise and may hire their own experts to do so.

In a “calories in, calories out” world, there’s room for all foods in a “healthy” diet.

Beyond the obvious material costs to stakeholders of changing the current nutritional paradigm are the much more difficult to quantify costs of changing people’s beliefs about such things. Despite taking a nutrition course years ago (for an easy science credit, I will admit), I did not have particularly strong thoughts about nutrition prior to about a year and a half ago. I knew I made less than optimal choices about what I ate (according to conventional wisdom that is) but I mostly ignored those concerns since my health seemed fine (more or less). It was therefore fairly costless for me to change my mind about how I approach my diet after the conventional wisdom failed for me. Physicians and dietitians are not like me, however. Many of them have devoted years of their lives to dispensing information and advice that they believe to be correct and helpful. Faced with an opposing and incongruent view, it is perfectly understandable that they would be very resistant to the implication that they have been misleading their patients. In a less extreme form, I am sometimes asked by friends and acquaintances for my thoughts relating to diet and health and then, after giving them, met with resistance and facts or beliefs that supposedly refute my position(s). Most of these people are not experts on this topic but, like most people, they need some justification for what they believe.

So what is my point in all this? It is probably not breaking news that people’s eating decisions are not purely based on a careful reading of the scientific evidence. Better science is probably a necessary part of making the case but I do not think it will be sufficient to affect the type of change that many people in the ‘Paleo’ or ‘Ancestral Health’ communities (or whatever other term you prefer) would like to see. As mentioned, most people are averse to the notion that their beliefs are wrong and, in my experience, will try to come up with some reason for why that is not the case, sometimes resorting to questionable sources for support. This is human nature, I think– cognitive dissonance perhaps, to borrow a term from the psychologists. Based on what I can see, most people are not even willing to entertain the idea that there is a controversy or room for debate about these competing paradigms. Especially skinny people.

I think this state of affairs needs to change if further research is to bear any fruit in the form of affecting individual behavior and/or public policy. Fortunately, there are many bloggers writing on this topic, all bringing their own perspectives to the table. The challenge will be finding enough common ground to get this message to a larger audience so that we get an actual public debate going. I read the New York Times ‘Health’ section fairly regularly (as a barometer for this type of thing, not necessarily for good information) and I am not seeing it so far. It would be a real shame if all that came of this renewed interest in an old paradigm was a relatively minor reduction in the prevalence of obesity.

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My good friend, Laura Schoenfeld, must have just returned from the UNC-Chapel Hill MPH/RD program’s annual field trip to Washington, DC, because she just wrote a terrific blog post about her experiences. It reminded me of my own field trip a few years back, as she reports hearing “statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we don’t know how to get them to eat that way.” Yup–the science of what we should eat is almost irrelevant. Read the whole post. It’s gem.

One of the major themes I heard come up over and over during our three days in Washington D.C. was the emphasis on “science-based” nutrition policy. From the Dietary Guidelines themselves, to the policies created to enact the guidelines, to the food manufacturers’ efforts to create product based on those guidelines, it would seem that taking an evidence-based approach is the gold standard for nutrition in our country. After all, why would we want to enact national nutrition policies that cost billions of dollars but don’t actually work?

The major issue I saw over the three days was that most of the speakers were under the impression that their understanding of nutrition science was infallible and completely up-to-date. I heard statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we…

The truth is that I get most of my political insight from Mad Magazine; they offer the most balanced commentary by far. However, I’ve been very interested in the fallout from the recent election, much more so than I was in the election itself; it’s like watching a Britney Spears meltdown, only with power ties. I kept hearing the phrase “epistemic closure” and finally had to look it up. Now, whether or not the Republican party suffers from it, I don’t care (and won’t bother arguing about), but it undeniably describes the current state of nutrition. “Epistemic closure” refers to a type of close-mindedness that precludes any questioning of the prevailing dogma to the extent that the experts, leaders, and pundits of a particular paradigm:

Forget about the Republicans. Does this not perfectly describe the public health leaders that are still clinging blindly to the past 35 years of nutritional policy? The folks at USDA/HHS live in their own little bubble, listening only to their own experts, pretending that the world they live in now can be returned to an imaginary 1970s America, where children frolicked outside after downing a hearty breakfast of sugarless oat cereal and grown-ups walked to their physically-demanding jobs toting homemade lunches of hearty rye bread and shiny red apples.

Remember when all the families in America got their exercise playing outside together—including mom, dad, and the maid? Yeah, me neither.

So let me rephrase David Frum’s quote above for my own purposes: Nostalgia for a misremembered past is no basis for feeding a diverse and advancing nation.

If you listen to USDA/HHS, our current dietary recommendations are a culmination of science built over the past 35 years on the solid foundation of scientific certainty translated into public health policy. But this misremembered scientific certainty wasn’t there then and it isn’t here now; the early supporters of the Guidelines were very aware that they had not convinced the scientific community that they had a preponderance of evidence behind them [1]. Enter the first bit of mommy-state* government overreach. When George McGovern’s (D) Senate Select Committee came up with the 1977 Dietary Goals for Americans, it was a well-meaning approach to not only reduce chronic disease, a clear public health concern, but to return us all to a more “natural” way of eating. This last bit of ideology reflected a secular trend manifested in the form of the Dean Ornish-friendly Diet for a Small Planet, a vegetarian cookbook that smushed the humanitarian and environmental concerns of meat-eating in with some flimsy nutritional considerations, promising that a plant-based diet was the best way to feed the hungry, save the planet, safeguard your health, and usher in the Age of Aquarius. This was a pop culture warm-fuzzy with which the “traditional emphasis on the biochemistry of disease” could not compete [2].

If you listen to some folks, the goofy low-fat, high-carb, calories in-calories out approach can be blamed entirely on this attempt of the Democrats to institutionalize food morality. But, let’s not forget that the stage for the Dietary Guidelines fiasco was set earlier by Secretary of Agriculture Earl Butz, an economist with many ties to large agricultural corporations who was appointed by a Republican president. He initiated the “fencerow to fencerow” policies that would start the shift of farm animals from pastureland to feed lots, increasing the efficiency of food production because what corn didn’t go into cows could go into humans, including the oils that were a by-product of turning crops into animal feed. [Update: Actually, not so much Butz’s fault, as I’ve come to learn, because so many of these policies were already in place before he came along. Excellent article on this here.]

When Giant Agribusiness—they’re not stupid, y’know—figured out that industrialized agriculture had just gotten fairydusted with tree-hugging liberalism in the form of the USDA Guidelines, they must have been wetting their collective panties. The oil-refining process became an end in itself for the food industry, supported by the notion that polyunsaturated fats from plants were better for you than saturated fats from animals, even though evidence for this began to appear only after the Guidelines were already created and only through the status quo-confirming channels of nutrition epidemiology, a field anchored solidly in the crimson halls of Harvard by Walter Willett himself.

Between Earl Butz and McGovern’s “barefoot boys of nutrition,” somehow corn oil from refineries like this became more “natural” than the fat that comes, well, naturally, from animals.

And here we are, 35 years later, trying to untie a Gordian knot of weak science and powerful industry cemented together by the mutual embarrassment of both political orientations. The entrenched liberal ivory-tower interests don’t want look stupid by having to admit that the 3 decades of public health policy they created and have tried to enforce have failed miserably. The entrenched big-business-supporting conservative interests don’t want to look stupid by having to admit that Giant Agribusiness, whose welfare they protect, is now driving up government spending on healthcare by acting like the cigarette industry did in the past and for much the same reasons.

These overlapping/competing agendas have created the schizophrenic, conjoined twins of a food industry-vegatarian coalition, draped together in the authority of government policy. Here the vegans (who generally seem to be politically liberal rather than conservative, although I’m sure there are exceptions) play the part of a vocal minority of food fundamentalists whose ideology brooks no compromise. (I will defend eternally the right for a vegan–or any fundamentalist–to choose his/her own way of life; I draw the line at having it imposed on anyone else–and I squirm a great deal if someone asks me if that includes children.) The extent to which vegan ideology and USDA/HHS ideology overlap has got to be a strange bedfellow moment for each, but there’s no doubt that the USDA/HHS’s endorsement of vegan diets is a coup for both. USDA/HHS earns a politically-correct gold star for their true constituents in the academic-scientific-industrial complex, and vegans get the nutritional stamp of approval for a way of eating that, until recently, was considered by nutritionists to be inadequate, especially for children.

Like this chicken, the USDA/HHS loves vegans—at least enough to endorse vegan diets as a “healthy eating pattern.”

But if the current alternative nutrition movement is allegedly representing the disenfranchised eaters all over America who have been left out of this bizarre coalition, let us remember that, in many ways, the “alternative” is really just more of the same. If the McGovern hippies gave us “eat more grains and cereals, less meat and fat,” now the Republican/Libertarian-leaning low-carb/primaleo folks have the same idea only the other way around—and with the same justification. “Eat more meat and fat, fewer grains and cereals;” it’s a more “natural” way to eat.

As counterparts to the fundamentalist vegans, we have the Occupy Wall street folks of the alternative nutrition community—raw meaters who sleep on the floor of their caves and squat over their compost toilets after chi running in their Vibrams. They’re adorably sincere, if a little grubby, and they have no clue how badly all the notions they cherish would get beaten in a fight with the reality of middle-Americans trying to make it to a PTA meeting.

How paleo might look from the outside.

To paraphrase David Frum again, the way forward in food-health reform is collaborative work, and although we all have our own dietary beliefs, food preferences, and lifestyle idiosyncrasies, the immediate need is for a plan with just this one goal: we must emancipate ourselves from prior mistakes and adapt to contemporary realities.

Because the world in which we live is not the Brady Bunch world that the many of us in nutrition seem to think it is.

Right now, it is in the best interest of both parties to stick to our dead nutrition policies and dump the ultimate blame on the individuals (we gave you sidewalks and vegetable stands–and you’re still fat! cry the Democrats; we let the food industry have free reign so you could make your own food choices–and you’re still fat! cry the Republicans). It’s a powerful coalition, resistant to change no matter who is in control of the White House or Congress.

What can be done about it, if anything? To paraphrase Frum once again, a 21st century food-health system must be economically inclusive, environmentally responsible, culturally modern, and intellectually credible.

We can start the process by stopping with the finger-pointing and blame game, shedding our collective delusions about the past and the present, and recognizing the multiplicity of concerns that must be addressed in our current reality. Let’s begin by acknowledging that—for the most part—the people in the spotlight on either side of the nutrition debate don’t represent the folks most affected by federal food-health policies. It is our job as leaders, in any party and for any nutritional paradigm, to represent those folks first, before our own interests, funding streams, pet theories, or personal ideologies. If we don’t, each group—from the vegatarians to folks at Harvard to the primaleos—runs the risk of suffering from its own embarrassing form of epistemic closure.

Let’s quit bickering and get to work.

**********************************************************

*This was too brilliant to leave buried in the comments section:

“Don’t you remember the phrase “wait til your father gets home”? You want to know what the state is? It’s Big Daddy. Doesn’t give a damn about the day to day scut, just swoops in to rescue when things get out of hand and then takes all the credit when the kids turn out well, whether it’s deserved or not. Equates spending money with parenting, too.”–from Dana

So from henceforth, all my “mommy-state” notions are hereby replaced with “Big Daddy,” a more accurate and appropriate metaphor. And I never metaphor I didn’t like.

References:

1. See Select Committee on Nutrition and Human Needs of the United States Senate. Dietary Goals for the United States. 2nd ed. Washington, DC: US Government Printing Office; 1977b. Dr. Mark Hegsted, Professor of Nutrition at Harvard School of Public Health and an early supporter of the 1977 Goals, acknowledged their lack of scientific support at the press conference announcing their release: “There will undoubtedly be many people who will say we have not proven our point; we have not demonstrated that the dietary modifications we recommend will yield the dividends expected . . . ”

2. Broad, WJ. Jump in Funding Feeds Research on Nutrition. Science, New Series, Vol 204. No. 4397 (June 8, 1979). Pp. 1060-1061 + 1063-1064. In a series of articles in Science in 1979, William Broad details the political drama that allowed the “barefoot boys of nutrition” from McGovern’s committee to put nutrition in the hands of the USDA.

1. the n of 1 view: what works for you is what works, this is all that matters, end of story.

2. the Platonic view: this is how your body/metabolism works, and so this is what you should do and if it isn’t working you probably are not doing right.

I think many of us start off being interested in nutrition because we like to know stuff, and knowing stuff about how to be healthy and fit is really cool because then you get to look better in your bathing suit than most or you can solve health problems that others can’t or any number of other minor acts of smug superiority masquerading as an objective search for knowledge. When we start out, we usually are completely immersed in perspective #2, that there is a “right” way to eat and exercise. We figure out what the “right” way is through various forms of scientific investigation/reporting brought to us by experts and/or the media; we apply that magic formula to ourselves, and we wait for the magic results to happen. If we are young and unencumbered by reality, they usually do—no matter what formula for fitness and health we’ve chosen from the ones offered by the experts—and we congratulate ourselves for our hard work and strength of character.

For many of us, somewhere along the line, the magic formula stops working, or we stop working at the magic formula, or a little (or a lot) of both.

Some of us respond to this by looking for the next—better, easier, quicker, more doable—magic formula. Some of us respond by working even harder at the magic formula we haven’t given up on—yet. Some of us give up looking and trying because life is hard enough already.

But that doesn’t mean we’ve given up on the idea that there is a “right” way to go about being healthy. I was a low-fat vegetarian eater for 16 years because I thought it was the “right” way to eat. I’ve been a (mostly) low-carb, animal eater for 13 years, during most of which I thought I’d—finally—found the really “right” way to eat.

What I’d really found was a new and different way to be wrong.

I wasn’t wrong about the diet plan–for me. It helped me lose 60 pounds that I’ve kept off for 13 years without hunger, without a calculator, and without having to exercise more than I want to. What I was wrong about was being right. I was wrong about the magic formula—any magic formula.

[In blog posts yet to come, I’ll tell you all the story of the woman who changed my perspective on everything.]

I hate being wrong (although goodness knows I’m really good at it, from years of practice). I really want there to be a formula, magic or otherwise. I like order, routine, facts, and answers. Gray areas make me woozy. That’s why I love biochemistry. It’s a game with nothing but rules that, literally, every body has to follow.

But, to quote Andrew Abrahams again, a detailed understanding of the minutiae of biochemical mechanisms doesn’t really help us in the big messy world of real people. Although everyone is subject to the same biochemical rules, how those rules play out in any given individual is difficult—perhaps impossible—to predict.

I salute the work that Gary Taubes and Peter Attia are doing with NuSI, which will focus on providing randomized controlled experimental evidence regarding nutritional interventions. The idea is to have both highly controlled experiments and more “real world” ones. Hooray for both. These experiments may help us understand how well certain nutrition interventions work—in experimental situations with a selected group of individuals. As awesome as this might be for a scientific pursuit, this science still may not be of much help for you personally, depending on how closely matched you feel your life and your self are to the experimental conditions—and it won’t provide any easy answers for the hardest issue of all, public health policy.

One big long experiment

Is there a way to round up our messy, individual realities into comprehensible information that will eventually translate into meaningful policy? Maybe. Andrew Abrahams and others in the ancestral health community have been tossing around the idea of “n of 1” nutrition for a while. The basis for this approach is the idea that we all experiment. In fact, life is one big long experiment.

But how do we conduct these “n of 1” experiments in a manner that

helps the person doing the experiment learn the right lessons (rather than be distracted by coincidences or random events)?

As Andrew says, and I agree, individual characteristics, circumstances, and history are tremendously important as far as choosing food and activity that works for you. His idea is to create a way to help people with this n of 1 experimentation so they can evaluate how their body will respond to changes and find what’s right for them.

The purpose of this community would be to capture the wide variety of attributes that may contribute to the outcomes for any individual, and provide modeling tools that can help people make the right decisions about what changes to make.

From a participant’s perspective, it would:

provide a way for you to observe and analyze personal health in an organized and (more or less) objective fashion

give direction, support, and structure to your own n of 1 experimentation

create a community of fellow experimenters with whom you could compare/contrast results

From a health professional’s perspective, it would:

provide a way to assist clients/patients in find what works best for them without a superimposing “it’s supposed to work this way for everyone” bias

create a set of algorithms for adapting common patterns to individualized recommendations and further experimentation

For example: A postmenopausal female who wants to lose weight may start one way and experiment in a series of steps that is different from, say, a 30-year old marathoner who wants to have a healthy pregnancy.

From a researcher’s perspective, it would:

create a way to structure and conduct experiments across a variety of nutritional (and other) factors

allow sharing and analysis of both pooled results and case studies/series of relevant community members or subpopulations with common characteristics

develop tools allowing one to interpret the community results in an individual context, make predictions and suggest “next steps”

contribute to the development of modeling systems for complex and interrelated inputs and outputs

A different question means a different approach to public health

I see the value of n=1 as a scientific pursuit because it will teach us to ask a very different question than the one we’ve been asking. We’ve been asking, “What way of eating will prevent chronic disease in most/all Americans?” Typically, nutrition epidemiology is recruited to try to answer that question with the idea that there is some factor or factors (like smoking and lung cancer) that can be included/eliminated to reach this goal. We’ve been so phenomenally unsuccessful at chronic disease prevention with our current population-wide model that I think a new framework of investigation is needed. Thus, n of 1 investigation changes the question to something more like: “What way of eating will bring improved health to you now?”

As people make incremental changes toward shorter-term personal health goals, modeling tools can be used to map out “nearest neighbor” communities. These communities may be similar in terms of personal characteristics and health history, but also attributes relating to culture, region, lifestyle, ethnic and family background, education, income, etc. Over time, this information will reflect long-term health outcomes built on a background of complex human traits interacting with complex human environments.

The complexity of n of 1 nutrition seems to be the very opposite of public health nutrition. And it would be naïve to think that the concept of n of 1 will not be at least partially co-opted by the food, drug, and research industries (“Try new Methylation Carbonation –for PEMT polymorphisms!”). But by its very nature, n of 1 nutrition resists being turned into yet another “magic formula.” More importantly, it reframes our current approach to public health nutrition along two very important lines:

First, it weakens the current public health message that a one-size-fits-all dietary recommendation is appropriate. This is especially important because it has been assumed for 30+ years that dietary recommendations that are normed on one population are equally applicable to other populations. A landmark study published in 2010 shows that African-Americans who consumed a “healthier” diet according to Dietary Guidelines standards actually gained more weight over time than African-Americans who ate a “less healthy” diet [1].

DQI stands for Diet Quality Index. Blacks with a higher DQI had more weight gain over time than blacks with a lower DQI. From [1]

Second, n of 1 nutrition emphasizes the need to return to a focus on the provision of basic nutritional needs rather than prevention of chronic disease. Balancing the complexity of the n of 1 concept (i.e. each human is radically different from another) with the simplicity of promoting/understanding essential nutrition (i.e. but each human shares these same basic needs provided by food) moves us away from the prevention model to the provision model. And the literature is pretty straightforward about what our basic nutritional needs are:

essential amino acids

essential fatty acids

vitamins and minerals

sufficient energy

Notice anything missing on that list of essentials? As the Institute of Medicine’s Food and Nutrition Board says: “The lower limit of dietary carbohydrate compatible with life is apparently zero” (DRI, Ch. 6, 275) [2]. This doesn’t mean you can’t or shouldn’t eat carbohydrate foods, or that some carbohydrate foods aren’t beneficial for some people or even many people. Indeed, some of my best friends are carbs. But dietary carbohydrate is not an essential component of our nutritional needs and never has been (although it is a fine source of energy if energy is what is you need and you aren’t wearing a 6-month supply on your backside like I am). Rather, carbohydrate has been recommended as the source of the majority of our calories as a means of replacing the fat, saturated fat, and cholesterol that we’ve been told cause chronic disease.* This recommendation seems to have conveniently upsized the market for the industrialized and heavily marketed foods—made mostly from corn, wheat, and soy—that take up most of the space on our grocery store shelves.

But I think the most significant ramification of the history of our Dietary Guidelines is not its effect on diet so much as the acceptance of the notion that something as intimately and intricately related to our health, culture, personality, lifestyle, family, and history as food can and should be directed—in a most comprehensive manner—from a place exceedingly remote from the places where we actually get fed.

Focus on community

While the ostensible focus of n of 1 nutrition is the individual, the real focus is the community. Advances in both biological and social sciences are increasingly focused on what are now considered to be the primary determinants of health status for an individual: that person’s genetic community and that person’s present community. What health behaviors you as an individual think you “choose” have already been largely determined by social factors: culture, socioeconomic status, education, etc. Those behaviors interact with genetic and epigenetic mechanisms that you didn’t have much choice about either. Although every individual has some control over his/her health behaviors, many of the health outcomes that we think of as being a result of “individual choice” are already largely predetermined.

One of the enduring myths of healthcare in the US is that there are some folks out there who “choose” poor health. Maybe there are, but I’ve met a lot of people in poor health, and I’ve never met anyone who deliberately chose it.

As we find virtual “nearest neighbor” communities in our n of 1 nutrition database, we may be able to use this information to assist real communities to develop their own appropriate food-health systems. Despite our increasing diversity, much of America still clusters itself in communities that reflect shared characteristics which play leading roles in health and health behavior. Culturally-influenced food preferences and nutrition beliefs may be part of that community formation and/or may reinforce those communities. With scientific tools that embrace complexity and diversity, we can honor those characteristics that make one community (real or virtual) different from the next, rather than ignore them.

N of 1 nutritional approaches will give us a new way to think about public health nutrition and the individuals and communities most affected by nutrition policy. I’m proud to say that Healthy Nation Coalition will be supporting the project.

Up next: My take on why nutrition is a feminist issue, or “I am Woman, hear my stomach growl.”

*While on a field trip to Washington, DC in January of 2010, I met Linda Meyers, one of the authors of reference #2 below. I asked her why carbohydrates were recommended as such a large part of our diet if there is no essential requirement for them. Her response was that the recommendation was based on prevention of chronic disease. I’m still not sure I get that.